Homeostasis  Endocrine system.

The endocrine system uses the release and

action of hormones to maintain homeostasis.
Homeostasis is the dynamic process in which the body maintains Body Fluids
balance by constantly adjusting to internal and external stimuli.
Fluids make up a large portion of the body, which is approximately
Negative and Positive Feedback 50%-60% of the total body weight.

 Feedback is the relaying of information about a given Location of Fluids

condition to the appropriate organ or system.
 Negative feedback. Negative feedback occurs when the  Main compartments. Body fluids are divided into two main
body reverses an original stimulus for the body to regain compartments: the intracellular fluid and the extracellular fluid
physiologic balance. compartments.
 Positive feedback. Positive feedback enhances or intensifies  Intracellular fluid. Intracellular fluid functions as a stabilizing
the original stimulus. agent for the parts of the cell, helps maintain cell shape and
 Examples. Blood pressure control and maintenance of normal assists with transport of nutrients across the cell membrane, in
body temperature are examples of negative feedback while and out of the cell.
blood clotting after an injury and a woman in labor are  Extracellular fluid. Extracellular fluid mostly appears as
examples of positive feedback. interstitial tissue fluid and intravascular fluid.
Systems Involved in Feedback Fluid Regulation Mechanisms

The major systems involved in feedback are the nervous and endocrine  The thirst center. The thirst center in
systems. the hypothalamus stimulates or inhibits the desire for a person
to drink.
 Nervous system. The nervous system regulates homeostasis by  Antidiuretic hormone. ADH regulates the amount of water
sensing system deviations and sending nerve impulses to the kidney tubules absorb and is released in response to low
appropriate organs. blood volume or in response to an increase in the concentration
of sodium and other solutes in the intravascular fluids.
  The RAA system. The RAA system controls fluid volume, in  Treatment of edema. Diuretics are commonly given for
which when the blood volume decreases, blood flow to the systemic edema.
renal juxtaglomerular apparatus is reduced, thereby activating Dehydration
the RAA system.
 Atrial natriuretic peptide. The heart also plays a role in  Dehydration. Dehydration is a deficiency of body water or

correcting overload imbalances, by releasing ANP from the excessive loss of water.

right atrium.  External causes. External causes of dehydration include

Normal Intake and Output prolonged sun exposure and excessive exercise, as well
as diarrhea, vomiting, and burns.
 Daily intake. An adult human at rest takes appropriately 2,500  Treatment of dehydration. Supplemental fluids and
ml of fluid daily. electrolytes are often administered.
 Levels of intake. Approximate levels of intake include fluids Electrolytes
1, 200 ml, foods 1, 000 ml, and metabolic products 30 ml.
 Daily output. Daily output should be approximately equal in An electrolyte is a substance that will disassociate into ions when

intake. dissolved in water.

 Normal output. Normal output occurs as urine, breathing,

 Origins. Electrolytes are found in the form of inorganic salts,
perspiration, feces, and in minimal amounts of vaginal
acids, and bases.
secretions.
 Active chemicals. Electrolyte concentrations are measured
Overhydration and Edema
according to their chemical activity and expressed as
 Overhydration. Overhydration is an excess of water in the milliequivalents.
body.  Ions. Each chemical element has an electrical charge, either
 Edema. Edema is the excess accumulation of fluid in positive or negative.
interstitial tissue spaces, also called third-space fluid.  Intracellular electrolytes. Important intracellular electrolytes
 Cause of edema. Edema is caused by a disruption of the are potassium, magnesium, sulfate, and phosphate, and the
filtration and osmotic forces of the body’s circulating fluids. most dominant cation is potassium while the most dominant
anion is phosphate.
  Extracellular electrolytes. Important extracellular electrolytes  Diffusion. Diffusion, or the process of “being widely spread”,
include sodium, chlorine, calcium, and bicarbonate, and the is the random movement of molecules from an area of higher
most essential cation is sodium while chlorine is the most concentration to an area of lower concentration.
important anion.  Osmosis. Osmosis is the diffusion of a pure solvent, such as
Fluid and Electrolyte Transport water, across a semipermeable membrane in response to a
concentration gradient in situations where the molecules of a
Total electrolyte concentration affects the body’s fluid balance. higher concentration are non-diffusible.
 Filtration. Filtration is the transport of water and dissolved
 The body cells. Nutrients and oxygen should enter body cells
materials concentration already exists in the cell.
while waste products should exit the body.
Active Transport
 The cell membrane. The cell membrane separates the
intracellular environment from the extracellular environment.  Mechanisms. Active transport mechanisms require specific
 Permeability. The ability of a membrane to allow molecules to enzymes and energy expenditure in the form of adenosine
pass through is known as permeability. triphosphate (ATP).
Permeability of Membranes  Processes. Active transport processes can move solutes
“uphill”, against the normal rules of concentration and
 Freely permeable membranes. These membranes allow
pressure.
almost any food or waste substance to pass through.
Fluid and Electrolyte Balance
 Selectively permeable. The cell membrane is selectively
permeable, meaning that each cell’s membrane allows only Fluid and electrolyte balance is vital for the proper functioning of all
certain specific substances to pass through. body systems.
Passive Transport
 Osmolarity. This is the property of particles in a solution to
 Passive transport. Passive transport mechanisms include dissociate into ions.
diffusion, osmosis, and filtration.  Electroneutrality. This is the balance of positive and negative
charges.
Acid-Base Balance Buffers

Acid-base balance is another important aspect of homeostasis.  Buffers. A buffer is a chemical system set up to resist changes,
particularly in hydrogen ion levels.
Acid, Bases, and Salts  Bicarbonate buffer system. Sodium bicarbonate and carbonic
acid are the body’s major chemical buffers.
 Acid. An acid is one type of compound that contains the
 Carbon dioxide. The major compound controlled by the lungs
hydrogen ion.
is CO2, and the respiratory system can very rapidly
 Base. A base or alkali is a compound that contains the
compensate for too much acid and too little acid by increasing
hydroxyl ion.
or decreasing the respiratory rate, thereby altering the level of
 Salt. Salt is a combination of a base and an acid and is created
CO2.
when the positive ions of a base replace the positive hydrogen
 Bicarbonate. Bicarbonate ions are basic components in the
ions of an acid.
body, and the kidneys are key in regulating the amount of
 Important salts. The body contains several important salts like
bicarbonate in the body.
sodium chloride, potassium chloride, calcium chloride, calcium
 Measurement of arterial blood gas. The pH level and
carbonate, calcium phosphate, and sodium phosphate.
amounts of specific gases in the blood indicate if there is more
Potential of Hydrogen
acid or base and their associated values.
 Respiratory acidosis. Respiratory acidosis occurs when
 pH. The symbol of pH refers to the potential or power of
breathing is inadequate and PaCO2 builds up.
hydrogen ion concentration within the solution.
 Respiratory alkalosis. Respiratory alkalosis occurs as a result
 Low pH. If the pH number is lower than 7, the solution is
of hyperventilation or excess aspirin intake.
an acid.
 Metabolic acidosis. In metabolic acidosis, metabolism is
 High pH. If the pH is greater than 7, a solution is basic or
impaired, causing a decrease in bicarbonates and a buildup of
alkaline.
lactic acid.
 Neutral pH. If the pH is 7, then the solution is neutral.
 Changes. A change in the pH of a solution by one pH unit
means a tenfold change in hydrogen concentration.
  Metabolic alkalosis. Metabolic alkalosis occurs when  Hypercalcemia is calcium level greater than 10.2 mg/dl.
bicarbonate ion concentration increases, causing an elevation in  Hypomagnesemia refers to a below-normal serum
blood pH. magnesium concentration.
Classification  Hypermagnesemia are serum levels over 2.3 mg/dl.
 Hypophosphatemia is indicated by a value below 2.5 mg/dl.
There are different fluid volume disturbances that may affect an  Hyperphosphatemia is a serum phosphorus level that exceeds
individual. 4.5 mg/dl in adults.
Pathophysiology
 Fluid volume deficit or hypovolemia occurs when the loss of
ECF volume exceeds the intake of fluid. Nurses need an understanding of the pathophysiology of fluid and
 Fluid volume excess or hypervolemia refers to electrolyte balance to anticipate, identify, and respond to possible
an isotonic volume expansion of the ECF caused by the imbalances.
abnormal retention of water and sodium in approximately the
same proportions in which they normally exist in the ECF.  Concentrations. Electrolyte concentrations vary from those in
Disturbances in electrolyte balances are common in clinical practice the ICF to those in the ECF.
and must be corrected.  Sodium. Sodium ions outnumber any other cations in the ECF;
therefore it is essential in the fluid regulation of the body.
 Hyponatremia refers to a serum sodium level that is less than  Potassium. The ECF has a low concentration of potassium and
135 mEq/L can tolerate only small changes in its concentrations.
 Hypernatremia is a serum sodium level higher than 145  Maintenance. The body expends a great deal of energy in
mEq/L. maintaining the sodium and potassium concentrations through
 Hypokalemia usually indicates a deficit in total potassium cell membrane pumps that exchange sodium and potassium
stores. ions.
 Hyperkalemia refers to a potassium level greater than 5.0  Osmosis. When two different solutions are separated by a
mEq/L. membrane that is impermeable to the dissolved substances,
 Hypocalcemia are serum levels below 8.6 mg/dl. fluid shifts from the region of low solute concentration to the
 high solute concentration until the solutions are of equal  Medications. There are certain medications that could lead to
concentration. electrolyte imbalances when taken against the physician’s
 Diffusion. Diffusion is the natural tendency of a substance to orders.
move from an area of higher concentration to an area of lower Clinical Manifestations
concentration.
Causes Signs and symptoms that occur in fluid and electrolyte imbalances are
discussed below.
Causes of fluid and electrolyte imbalances are discussed below in
general.  Fluid volume deficit. Clinical signs and symptoms include
acute weight loss, decreased skin turgor, oliguria, concentrated
 Fluid retention. Retention of sodium is associated with fluid urine, orthostatic hypotension, a weak, rapid heart rate,
retention. flattened neck veins, increased temperature, thirst, decreased or
 Loss of sodium. Excessive loss of sodium is associated with delayed capillary refill, cool, clammy skin, muscle weakness,
decreased volume of body fluid. and cramps.
 Trauma. Trauma causes release of intracellular potassium  Fluid volume excess. Clinical manifestations of FVE include
which is extremely dangerous. edema, distended neck veins, and crackles.
 Loss of body fluids. FVD results from loss of body fluids and  Hyponatremia. Signs and symptoms
occurs more rapidly when coupled with decreased fluid intake. include anorexia, nausea and vomiting, headache, lethargy,
 Fluid overload. Fluid volume excess may be related to a dizziness, confusion, muscle cramps and weakness, muscular
simple fluid overload or diminished function of the twitching, seizures, dry skin, and edema.
homeostatic mechanisms responsible for regulating fluid  Hypernatremia. The signs and symptoms are thirsts, elevated
balance. body temperature, hallucinations, lethargy, restlessness,
 Low or high electrolyte intake. Diets low or excessive in pulmonary edema, twitching, increased BP, and pulse.
electrolytes could also cause electrolyte imbalances.
 Hypokalemia. Clinical manifestations are fatigue, anorexia,  Hyperphosphatemia. Clinical manifestations are tetany,
muscle weakness, polyuria, decreased bowel motility, tachycardia, anorexia, nausea and vomiting, muscle weakness,
paresthesia, ileus, abdominal distention, and hypoactive and hyperactive reflexes.
reflexes Complications
 Hyperkalemia. Signs and symptoms include muscle weakness,
tachycardia, paresthesia, dysrhythmias, intestinal colic, cramps, Fluid and electrolyte imbalances could result in complications if not

abdominal distention, and anxiety. treated promptly.

 Hypocalcemia. The signs and symptoms are numbness,

 Dehydration. Fluid volume deficit could result in dehydration
tingling of fingers, toes, and circumoral region, positive
of the body tissues.
Trousseau’s sign and Chvostek’s sign, seizures, hyperactive
 Cardiac overload. Fluid volume excess could result in cardiac
deep tendon reflexes, irritability, and bronchospasm.
overload if left untreated.
 Hypercalcemia. The signs and symptoms include muscle
 SIADH. Water is retained abnormally in SIADH.
weakness, constipation, anorexia, nausea and vomiting,
 Cardiac arrest. Too much potassium administered could lead
dehydration, hypoactive deep tendon reflexes lethargy, calcium
to cardiac arrest.
stones, flank pain, pathologic fractures, and deep bone pain.
Assessment and Diagnostic Findings
 Hypomagnesemia. Clinical manifestations include
neuromuscular irritability, positive Trousseau’s and Chvostek’s
The following are laboratory studies useful in diagnosing fluid and
sign, insomnia, mood changes, anorexia, vomiting, and
electrolyte imbalances:
increased deep tendon reflexes.
 Hypermagnesemia. Signs and symptoms are  BUN. BUN may be decreased in FVE due to plasma dilution.
flushing, hypotension, muscle weakness, drowsiness,  Hematocrit. Hematocrit levels in FVD are greater than normal
hypoactive reflexes, depressed respirations, and diaphoresis. because there is a decreased plasma volume.
 Hypophosphatemia. Signs and symptoms include  Physical examination. A physical exam is necessary to
paresthesias, muscle weakness, bone pain and tenderness, chest observe the signs and symptoms of the imbalances.
pain, confusion, seizures, tissue hypoxia, and nystagmus.  Serum electrolyte levels. Measurement of electrolyte levels
should be performed to check for the presence of an imbalance.
  ECG. ECG changes can also contribute to the diagnosis of  IV calcium gluconate. If serum potassium levels are
fluid and electrolyte imbalance. dangerously elevated, it may be necessary to administer IV
 ABG analysis. ABG analysis may reveal acid-base calcium gluconate.
imbalances.  Calcitonin. Calcitonin can be used to lower the serum calcium
Medical Management level and is particularly useful for patients with heart disease
or heart failure who cannot tolerate large sodium loads.
Treatment of fluid and volume imbalances needs accuracy to avoid Nursing Management
consequences that can result in complications.
Nurses may use effective teaching and communication skills to help
 Isotonic electrolyte solutions. These solutions are used to treat prevent and treat various fluid and electrolyte disturbances.
the hypotensive patient with FVD because they expand plasma
volume. Nursing Assessment
 Accurate I&O. Accurate and frequent assessments of I&O
should be performed when therapy should be slowed or Close monitoring should be done for patients with fluid and electrolyte

increased to prevent volume deficit or overload. imbalances.

 Dialysis. Hemodialysis or peritoneal dialysis is performed to

 I&O. The nurse should monitor for fluid I&O at least every 8
remove nitrogenous wastes and control potassium and acid-
hours, or even hourly.
base balance, and remove sodium and fluid.
 Daily weight. Assess the patient’s weight daily to measure any
 Nutritional therapy. Treatment of fluid and electrolyte
gains or losses.
imbalances should involve restrictions or enforcement of the
 Vital signs. Vital signs should be closely monitored.
concerned electrolyte.
 Physical exam. A physical exam is needed to reinforce other
Pharmacologic therapy
data about a fluid or electrolyte imbalance.
 AVP receptor agonists. These are new pharmacologic agents Diagnosis
that treat hyponatremia by stimulating free water excretion.
The following diagnoses are found in patients with fluid and
 Diuretics. To decrease fluid volume in FVE, diuretics are
electrolyte imbalances.
administered.
  Excess fluid volume related to excess fluid intake and sodium  Central nervous system changes. The nurse must be alert for
intake. central nervous system changes such as lethargy, seizures,
 Deficient fluid volume related to active fluid loss or failure of confusion, and muscle twitching.
regulatory mechanisms.  Diet. The nurse must encourage intake of electrolytes that are
 Imbalanced nutrition: less than body requirements related deficient or restrict intake if the electrolyte levels are excessive.
to inability to ingest food or absorb nutrients. Discharge and Home Care Guidelines
 Imbalanced nutrition: more than body requirements related
to excessive intake. After hospitalization, treatment and maintenance of the condition must

 Diarrhea related to adverse effects of medications or continue at home.

malabsorption.
 Diet. A diet rich in all the nutrients and electrolytes that a
Nursing Interventions
person needs should be enforced.
There are specific nursing interventions for fluid and electrolyte  Fluid intake. Fluid intake must take shape according to the
imbalances that can aid in alleviating the patient’s condition. recommendations of the physician.
 Follow-up. A week after discharge, the patient must return for
 Monitor turgor. Skin and tongue turgor are indicators of the a follow-up checkup for evaluation of electrolyte and fluid
fluid status of the patient. status.
 Urine concentration. Obtain urine sample of the patient to  Medications. Compliance with prescribed medications should
check for urine concentration. be strict to avoid recurrence of the condition.
 Oral and parenteral fluids. Administer oral or parenteral
fluids as indicated to correct the deficit.
 Oral rehydration solutions. These solutions provide
fluid, glucose, and electrolytes in concentrations that are easily
absorbed.